Searching for Adverse Effects in MEDLINE and EMBASE Requires a Combined Approach for Efficient Retrieval

Marcy L. Brown

摘要

A review of: Golder, Su, Heather M. McIntosh, Steve Duffy, and Julie Glanville. “Developing Efficient Search Strategies to Identify Reports of Adverse Effects in MEDLINE and EMBASE.” Health Information & Libraries Journal 23.1 (Mar. 2006): 3-12. Objective – To assess the sensitivity and precision of various search strategies for retrieving adverse effects studies from the MEDLINE and EMBASE databases. Design – Analytical survey. Subjects – A case study using a recently published systematic review of the effectiveness and adverse effects of seven new anti-epileptic drugs. Setting – MEDLINE and EMBASE searches performed by researchers at the Centre for Reviews and Dissemination and the UK Cochrane Centre Search Filters Design Group at the University of York, UK. Methods – Five key approaches to searching were defined. The first approach used either text words or controlled vocabulary to search for specific adverse effects. The second used subheadings or qualifiers either attached to drug names found in the controlled vocabulary (approach 2a) or ‘floating’ without drug names (approach 2b). The third approach used text words as synonyms for the phrase ‘adverse effects.’ The fourth used controlled indexing terms for adverse effects. The fifth and final approach used two published search strategies incorporating study design (Badgett et al., Loke et al.). These five approaches were used to search for studies of the adverse effects of seven new anti-epileptic drugs. 5,011 unique papers were retrieved. Of these, 236 were judged potentially relevant and 225 full text articles were obtained. The inclusion criteria from a previously published systematic review (Wilby et al.) were applied to the papers, and 79 met the criteria. Five papers were added to the set after being identified from reference lists, clinical experts, and other sources. This new set of 84 studies was used as a quasi gold standard (QGS) against which more than 300 combinations of the five approaches could be tested. To create the set of possible approaches, the researchers combined search strategies one through four in all possible ways, and used all available subheading combinations from 2a and 2b. The Badgett and Loke searches were tested separately. Main Results – Sensitivity and precision were determined for each combination. Formulas used to calculate sensitivity and precision were provided. In MEDLINE, search strategies using floating subheadings achieved the highest sensitivity. The most useful single subheading in both MEDLINE and EMBASE was “adverse effects,” with 79.1% and 79.5% sensitivity respectively. Of the more than 300 combinations tested, the most sensitive combination in MEDLINE included specified adverse effects in combination with the floating subheadings “adverse effects,” “complications,” and “drug effects,” together with text words for adverse effects. This strategy had 97.0% sensitivity, but low precision at 2.8%. The highest precision was achieved by using subheadings attached to drug indexing terms. In EMBASE, the strategy of Loke et al. provided the highest sensitivity at 86.3% and precision of 2.0%. Since researchers are not likely to know in advance all of the reported adverse effects of a particular drug therapy, the most sensitive strategies without specific adverse events were also identified. The search with the highest sensitivity in MEDLINE had 95.5% sensitivity, and 97.3% sensitivity in EMBASE. Conclusion – Searching for adverse effects requires a combination of approaches in both MEDLINE and EMBASE. In MEDLINE, the most sensitive combination yielded 97.0% sensitivity. Regardless of the approach used, precision remains low. An effective generic search filter for adverse effects searches may not yet be feasible. More research is needed on search strategies, as well as more consistent methods of reporting and indexing adverse effects.

机译：评论者：Golder，Su，Heather M. McIntosh，Steve Duffy和Julie Glanville。 “制定有效的搜索策略以识别MEDLINE和EMBASE中的不良反应报告。”健康信息与图书馆杂志23.1（2006年3月）：3-12。目的–评估从MEDLINE和EMBASE数据库检索不良反应研究的各种搜索策略的敏感性和准确性。设计–分析调查。受试者-使用最近发表的对七种新抗癫痫药的有效性和不良反应的系统评价进行的案例研究。设置– MEDLINE和EMBASE搜索，由英国评论和传播中心的研究人员以及英国约克大学的英国Cochrane中心搜索过滤器设计小组进行。方法–定义了五种关键搜索方法。第一种方法使用文本单词或受控词汇表来搜索特定的不利影响。第二个使用的副标题或限定词附加到在受控词汇表中找到的药物名称（方法2a）或不包含药物名称的“浮动”（方法2b）。第三种方法使用文本词作为“不良影响”短语的同义词。第四种方法使用受控索引术语来表示不良影响。第五种方法也是最后一种方法，它采用了两种结合了研究设计的公开搜索策略（Badgett等，Loke等）。这五种方法被用于寻找对七种新的抗癫痫药不良反应的研究。共检索到5,011篇独特的论文。其中，有236篇被认为可能相关，并获得了225篇全文文章。来自先前发表的系统评价（Wilby等人）的纳入标准应用于论文，有79项符合标准。从参考文献列表，临床专家和其他来源中识别出五篇论文后，将其添加到该集中。这套新的84项研究被用作准金标准（QGS），可以对这五种方法的300多种组合进行测试。为了创建一组可能的方法，研究人员以所有可能的方式将搜索策略组合为一到四种，并使用了2a和2b中所有可用的子标题组合。 Badgett和Loke搜索分别进行了测试。主要结果–确定每种组合的灵敏度和精密度。提供了用于计算灵敏度和精度的公式。在MEDLINE中，使用浮动小标题的搜索策略具有最高的敏感性。在MEDLINE和EMBASE中，最有用的单个子标题是“不良反应”，分别具有79.1％和79.5％的敏感性。在所测试的300多种组合中，MEDLINE中最敏感的组合包括特定的不良反应以及浮动副标题“不良反应”，“并发症”和“药物效应”，以及有关不良反应的文字。此策略的灵敏度为97.0％，但精度较低，为2.8％。通过使用附在药物索引项上的小标题，可以达到最高的精度。在EMBASE中，Loke等人的策略。提供了最高的灵敏度，为86.3％，精度为2.0％。由于研究人员不太可能事先知道特定药物疗法的所有不良反应，因此，还确定了没有特定不良事件的最敏感策略。在MEDLINE中具有最高灵敏度的搜索具有95.5％的灵敏度，在EMBASE中具有97.3％的灵敏度。结论–在MEDLINE和EMBASE中寻找不良影响需要多种方法的组合。在MEDLINE中，最敏感的组合产生97.0％的敏感度。无论使用哪种方法，精度都仍然很低。有效的通用搜索过滤器可能对不良影响搜索尚不可行。需要对搜索策略以及报告和索引不良影响的更一致方法进行更多研究。

Searching for Adverse Effects in MEDLINE and EMBASE Requires a Combined Approach for Efficient Retrieval

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